Apparatus And Method For The Treatment of Cataract

ABSTRACT

A method and related apparatus to treat a cataract where the cataractous lens is pierced and the resulting opening is mechanically maintained using a lens system device such as a pinhole device, expandable tubular leas, a stent or similar small diameter device, some of which are capable of supporting a secondary intraocular lens. The resulting passageway or lumen created in the cataractous lens allows visible light to better reach the retina, thus improving vision. This lens system device that can be placed into an in situ cataract provides for a much simpler surgical technique and reduces related pre and post operative procedures and potential complications. Intraocular lenses may also be used in concert with this invention. The apparatus and technique can be applied to humans as well as animals.

CROSS REFERENCE TO RELATED PATENT APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/691,81.0 filed Dec. 2, 2012 entitled “Method For The Treatment ofCataract” by Dr. David M. Kleinman of Rochester, N.Y., which is adivisional of U.S. patent application Ser. No. 12/581,152 filed Oct. 18,2009 entitled “Apparatus and Method For The Treatment of Cataract” byDr. David M, Kleinman of Rochester, N.Y., which claims priority to U.S.Patent Application Ser. No. 61/106,876 filed Oct. 20, 2008 entitled“Apparatus and Method For The Treatment of Cataract” by Dr. David M.Kleinman of Rochester, N.Y.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates generally to surgery of the eye, and moreparticularly to an apparatus and a method for the treatment, ofcataract.

2. Description of Related Art

Cataract is the leading cause of blindness in the world. There arecurrently over 100 million people in the world that have cataracts thatinterfere with visual function. In addition, there are currentlyapproximately 22 million people in the world who are completely blindfrom cataracts. The vast majority of these patients live in developingcountries. Despite modern surgical techniques, the rate of cataractblind increases annually. The prevalence of bilateral cataract blind iscurrently increasing by 1.5 million people per year. There are sevenmillion cataract surgeries performed annually, but the fact thatophthalmologists cannot remove the backlog of bilateral cataract blindor even keep up with the rates of new cataracts generally is clearevidence that a new methodology to deal with developing world cataractsis required.

Pediatric cataract is a devastating problem world wide, and itstreatment is very challenging. The disability and economic burden onfamilies, communities, and countries based on the combination ofpediatric and adult cataract is staggering.

Cataracts are an opacification of the natural, human lens. Currentmethods of cataract, treatment include removal of the lens, andrefractive correction. Oftentimes, an intraocular lens is used.Historically, the lens could be couched with a needle. There are nopharmacological treatments for cataract blind. It is purely a surgicaldisease. Extracapsular cataract extraction is a very effective methodfor treating cataract blind. Once the cataractous lens is removed, morelight will enter the eye; however, a method to focus the light (exceptin the tare case of very high myopes) is required. Either spectacles ora precise and calculated power of intraocular lens is required. Tochoose the correct power intraocular lens, biometry and keratometry arerequired. These technologies are often not available in the developingworld, and as a consequence, standard powered lenses are implanted inthe hope that most people will see substantially better.

The current invention not only describes a novel apparatus and methodfor treating millions of individuals blind from, cataract, and in someembodiments also reduces the need for precise refractive correctionafter cataract treatment.

It is thus an object of the present invention to provide an apparatusand method for treating cataract that can be performed in locationswithout extensive cataract treatment support infrastructure. It isanother object of the present invention to provide an apparatus andmethod for treating cataract that can be performed in locations withfewer specialized practitioners. It is another object of the presentinvention to provide an apparatus to treat cataract. It is yet anotherobject of the present invention to provide an apparatus to assist with anovel method of treating cataract.

BRIEF SUMMARY OF THE INVENTION

In accordance with the present invention, there is provided an apparatusfor treating cataract of art eye having a surgical tool formed with anangle to allow entry of the surgical tool through the peripheral corneaof the eye, the angle creating a longer operative end of the surgicaltool and a shorter surgical end of the surgical tool; the shortersurgical end of the surgical tool having a sharp tool for penetration ofa cataractous lens of the eye; a lens system device, or lumen creationsystem, contained within the surgical tool; and an advancing or guidingstructure attached to the lens system device and further disposed withinthe surgical tool. The present invention includes mechanisms to easeplacement of the lens system device into the cataract and to aid in therelease of such a placement apparatus from the deployed lens systemdevice.

The foregoing paragraph, has been provided by way of introduction, andis not intended to limit the scope of the invention and its variousembodiments described, depicted, or envisioned herein.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be described by reference to the following drawings,in which like numerals refer to like elements, and in which:

FIG. 1 depicts a surgical tool for the treatment of cataract;

FIG. 2 depicts a surgical tool for the treatment of cataract with aguide wire disposed within and through the surgical tool;

FIG. 3 depicts a surgical tool, for the treatment of cataract with aguide wire and lens system device installed;

FIG. 4 is a cross sectional view of an eye showing the surgicalincision;

FIG. 5 is a cross sectional view of an eye showing the surgical toolentering the incision;

FIG. 6 is a cross sectional view of an eye showing the surgical toolbeing rotated into position;

FIG. 7 is a cross sectional view of an eye showing the surgical tool inposition;

FIG. 8 is a cross sectional view of an eye showing the guide wire beingdeployed;

FIG. 9 is a cross sectional view of an eye showing the lens systemdevice being deployed;

FIG. 10 is a cross sectional view of an eye showing the lens systemdevice in position;

FIG. 11 is a cross sectional view of an eye showing the lens systemdevice expanded;

FIG. 12 is a cross sectional view of an eye showing the lens systemdevice in place with the guide wire removed; and

FIG. 13 is a cross sectional view of an eye showing a second embodimentof the lens system device in place with the guide wire removed;

The present invention will be described in connection with a preferredembodiment, however, it will be understood that there is no intent tolimit the invention to the embodiment described. On the contrary, theintent is to cover all alternatives, modifications, and equivalents asmay be included within the spirit and scope of the invention, as definedby this specification, claims, and the attached drawings.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

For a general understanding of the present invention, reference is madeto the drawings. In the drawings, like reference numerals have been usedthroughout to designate identical elements.

The present invention and the various embodiments described or suggestedherein rely on a surgical technique where the natural lens of the eye ispierced and the resulting opening is mechanically retained using adevice that operates in ways that may be similar to cardiovascularstenting technologies. The resulting passageway, lumen, or lens systemcreated in the natural or cataractous lens allows light to reach theretina, thus improving vision. The resulting passageway through thenatural lens is made through a diameter less than the diameter of thenatural lens. The use of this lens system device with or without thepinhole principle provides for a much simpler surgical technique andreduces related pre and post operative procedures.

The apparatus and method of the present invention may involve humaneases, and also may be critically important in pediatric cases, as lightwill be in focus on the retina, reducing the need for complex cataractsurgery followed by contact lenses or glasses in infants, and thus alsomay play a role in preventing ambylopia. In addition, veterinary casesof cataract such as those which develop in dogs, cats, horses, and thelike, may benefit from the apparatus and method of the present inventionand the various embodiments described or envisioned herein.

Turning now to the drawings, both an exemplary surgical device, as wellas related devices and methods, will be described using the drawingsattached herein.

In FIG. 1, a surgical tool, for the treatment of cataract is depicted.The surgical tool 100, in one embodiment, is essentially a hollow tubesuch as a cannula or related structure made from stainless steel,titanium, plastics, biocompatible polymers, or other material that isused to fabricate surgical instruments. The surgical tool 100 containsan angle 101. The angle is used to facilitate the method of the presentinvention, as will be further described herein. The angle may be ninety(90) degrees, as depicted, in FIG. 1, or it may be within approximatelysixty (60) degrees greater or less than ninety (90) degrees. Thesurgical tool 100 may, in some embodiments of the present invention,contain a sharp edge or other incision or cutting tool, such as, forexample, a trocar, to assist with the method of the present invention.The sharp tool would be located at 102.

FIG. 2 further depicts the surgical tool 100 with a guiding structure201 disposed within the surgical tool 100. The guiding structure, orguide wire in this example 201 must be capable of traveling through theangle 101 or conveying force through, the angle, and must be ofsufficient rigidity to support the piercing of the natural lens with itsrelated cataract. Materials for the guide wire may include stainlesssteel, titanium, Kevlar, encapsulated glass (fiber optic material), andthe like. Materials for the guiding structure may include metals,plastics, polymers, and the like. The guiding structure term isnomenclature that may include, but is not limited to, a guiding or lenssystem advancing structure, and also serves to reference a system thatwould deploy through the cannula for the purpose of piercing thecataractous lens allowing for the placement of the lens system device orstent or second permanent hollow cannula, lens, or lens system devicethat remains in the lens, or the guiding structure may be integral to,part of, or built into the surgical tool. The guiding structure may beone and the same as the surgical tool in some embodiments. The guidingstructure may also refer to a method for advancing the lens systemdevice into the cataractous lens. Heat, ultrasound, laser, or otherelectromechanical processes may he deployed at the tip to ease thepenetration of the system through the lens. The material or part of it,such as, for example, the leading or trailing ends, may also bebiodegradable material such as Polyglycolic acid polymers.

In FIG. 3 a lens system device 301, such as, for example a stent, isdepicted within the surgical tool 100. The stent may be similar instructure and concept to a cardiac stent, but will be dimensioned toaccommodate the procedure described herein. The lens system device 301is a tubular sleeve capable of expansion. An example of a cardiac stentis disclosed in U.S. Pat. No. 7,435,255 to Rao entitled “Drug FlutingStent and Methods of Making”, the entire disclosure of which, and thereferences cited therein, are incorporated in their entirety herein. Thelens system device 301 may be fabricated from a metallic material suchas stainless steel, platinum, titanium, tantalum, nickel-titanium,cobalt-chromium, and alloys thereof. In addition, the lens system device301 may further contain drugs that are carried in a polymeric coating orsleeve that may or may not be loaded with at least one therapeutic drug.Suitable polymers for the lens system device, with or without drugloading include, for example, poly(methyl methacrylate) (“PMMA”),poly(ethylene-co-vinyl alcohol) (“EVAL”), poly(butyl methacrylate)(“PBMA”), polyglycolic acid (“PGA”), poly(L-lactic acid) (“PLLA”), wovenpolymers, silicones, hydrogels, copolymers and blends thereof as well asvarious nanomaterials such as carbon nanotubes and the like, or otherpolymers used for biocompatible coatings, linings, or with drug deliverycapabilities familiar to those skilled in the art. The lens systemdevice may also be made from a hydrophilic material that expands uponplacement in an aqueous environment such as an eye. Suitable hydrophilicmaterials may include, but are not limited to,poly(2-Hydroxyemylmethacrylate) (pHEMA), hydroxyethyl methacrylate(HEMA), hydrophilic acrylic, hydrogels, hydrophilic polymers,fluorocarbon-sulfone. Thus, a dehydrated transparent hydrophilic polymerwould expand over time once placed in position through the cataract.Also depicted in FIG. 3 is a taper 303 that is an integral part of, or adetachable part of, the lens system device 301. The taper 303 allows thelens system device 301 to travel and insert into the created lumen inthe natural lens. This aspect to the device may also be capable oftransmitting heat, ultrasound, laser, or other electromechanicalenergies to ease placement through the cataractous lens. The taper 303may be present in some embodiments of the present invention, and may beabsent from the lens system device 301 in other embodiments of thepresent invention. The taper may, in some embodiments of the presentinvention, may be biodegradable, or threaded. In some embodiments of thepresent invention, the lens system device 301 may be surrounded by acomponent that would prevent lens material from entering the patentspace opened by the stent or lens system device. The component thatsurrounds the lens system device to keep the lens material out could bemade from DACRON® (polyethylene terephthalate fibers), GORE-TEX®(expanded polytetrafluoroethylene). Nylon, or other biodegradable ornon-biodegradable materials. This outer coating, or the entire lenssystem device could be made from intraocular lens material such asacrylic, PMMA, or silicon. There also may be an intraocular lenscontained in the lens system device, or deployed into it in anadditional step. The diameter of this lens system device would rangefrom less than 1 mm (0.59 mm minimum) up to 5 mm after expansion. Thelens system device may be completely embedded in or surrounded by theintraocular lens material or polymer that keeps, lens material out ofthe patent space through the lens. The lens system device may contain atubular, expandable. foldable or non foldable IOL or synthetic lensmaterial in its center. The lens power would range from −50 to +50diopters, but would, in one embodiment be +16 to +20 diopters. The lenssystem device may expand to 4 mm in one embodiment, but could functionwith diameters of between 2 and 5 mm. The lens system device or stentmay expand to 4 mm in one embodiment, but contain in the midpoint, ametal plate with a smaller opening (pinhole) in the range from 0.10 mmto 3 mm. In one embodiment, an opaque covering is placed with the lenssystem device that extends outside the anterior opening for 360 degreesaround reaching a diameter up to 8 mm but it could be as little as 1 mmwider than the central opening.

In use, the cataractous lens of a patient is pierced directly in thevisual axis with a sturdy material or device such as a wire, for examplethe guide wire 201, with or without an accompanying flexible or rigidcatheter, and a small stent or other small or medium sized diameterdevice is placed in the defect created. The new space created in thecataractous lens is maintained by a device such as a metal stent(titanium or other metals), or plastics (silicones, hydrogels or PMMA orothers), or a lens system device or tubular lens or other biocompatiblematerial. The stent or lens system device may be surrounded by abiocompatible shell such as Dacron®, Gore-Tex®, acrylic, PMMA, siliconeor any non absorbable or absorbable or biodegradable material tomaintain the patency of the newly created opening and to ensure lensmaterial does not enter into the full thickness hole in the lens(especially in the case of wire stents, but other scenarios as well).Polymer coatings may be hydrophilic or hydrophobic. The diameter of thepassageway or lumen or opening is typically 1.5 mm. to 3.5 mm., but itcan be smaller or larger. The tight fit of the lens system device 301,stent, lumen maintainer, tubular lens, or pinhole device adjacent to theanterior or posterior capsule will, prevent dissipation of lens materialinto the anterior or posterior segments; the lens capsule will be snugagainst the device. This procedure will not prevent traditional types ofcataract extraction in the future. Light will go through the smallaperture, lens system device, tubular lens, expandable tubular lens,tubular lens made from hydrogel polymers, or in some embodiments apinhole, and focus on the retina, because of A) refractive correction bythe patient, B) an intraocular lens in the system, C) the pinholeprincipal regardless of the refractive error of the eye, or D) the focusmay be suboptimal, but the vision provided will be superior to thevision with the cataract in place. In one embodiment, the vision willessentially be aphakic quality. In this scenario, there may be anopening, passageway, or lumen between 3 and 5 mm in diameter through thecataract. A secondary anterior chamber, or intraluminal lens may also beplaced either in front of or inside the lumen to correct refractiveerror. The method involves entering the peripheral cornea, openingthrough the lens a significant passageway for light, and maintaining itspatency with a specially designed device such as the lens system device301. The lens system device could be of polymeric, construction, forexample, PMMA, silicone, or acrylic construction, hydrogel construction,or titanium or other metals or other polymers or combinations thereof,possibly including other materials that, are used to treat cataracts ormanufacture stents or intraocular lenses. To gently pierce the cataract,a mechanized system may be required, such as using ultrasound energy,laser, heat, or other mechanical, means to allow the passage of theguiding system and or stent through the cataract. In one embodiment, asupporting instrument may be passed through the pars plana to stabilizethe lens for the procedure. Methods for stabilizing the lens when thesurgical tool and/or guiding structure is detached from the lens systemdevice or stent or removed from the eye are included as embodiments ofthe present invention and may include mechanical or other methods ofrelease systems. Other embodiments of the present invention use a screwtype technology to pierce and drive a guiding structure (with or withoutan accompanying flexible or rigid catheter, stent, balloon, orexpandable lens system) or other structure through a cataractous lens ina human or animal eye to create a clear space or tunnel for light topass through to preserve or improve sight. In one embodiment the lenssystem device or stent will be flexible enough to make the turn throughangle 101 in FIG. 1. In one embodiment, the rigidity of the stent issupplied by rings or spiral material inside the stent. The use of thistechnology is applicable and useful in human or animal lenses of anydensity and brunescence or any type of cataract including but notlimited to congenital, acquired, traumatic, nuclear, polar, cortical,posterior subcapsular, infectious, post operative, inflammatory. In thecase of some cataracts penetration of the lens material will be easier(pediatric or traumatic cataract) or more difficult (calcific, senile,or brunescent cataract). The system may be tunable so that less energyis used to penetrate one type of cataract versus another. In oneembodiment of the present invention, a mechanized, system is employedthat imparts rotational energy to the guiding structure, stentcomponents (all with or without threads), or both during the procedureto ease their passage into and through the cataractous lens. In otherembodiments, electrical, electrocautery, thermal, laser, ionization,chemical nuclear, or ultrasonic energy is used to aid in the penetrationof the cataractous lens and/or for the placement of the stent or lenssystem device that is integral to this invention.

FIGS. 4 through 13 provide examples of the steps involved in the methodsof the present invention, and also provide examples of how to use thesurgical tool and related implantable device of the present, invention.The examples provided in the figures are not to be construed aslimitations of the present invention and its various embodimentsdescribed herein, but rather, are depicted to fully allow one skilled inthe art to make and use the invention, along with modifications,adaptations, and alterations, all being within the spirit and broad,scope of the present invention as fully defined herein. FIGS. 4 through13 depict a human eye, but the methods and apparatus of the presentinvention are equally well adapted to veterinary medicine.

In FIG. 4, an eye 400 is depicted. An incision 401 is made in thecornea, the diameter of the incision, through the cornea can be between0.25 mm. and 2 mm., being self sealing, but may be up to 6 mm., and mayrequire surgical closure. In some embodiments of the present, invention,a support structure or support structures 403 may be used to hold thelens in place during surgery. In some embodiments of the presentinvention, a polymer block is used that rests externally on the eye tostabilize it so that when the guiding structure and/or surgical tool(with or without an accompanying flexible or rigid catheter) and otherrelated technologies are entered into the cornea, the eye is held steadyto minimize the risk of injury through movement. Viscoelastic, or otherviscous materials may be injected into the anterior chamber (and left inplace or washed out) during the procedure to maintain the anteriorchamber. Alternatively, a simple anterior chamber maintainer such as aneedle or Lewicky cannula may be used to maintain the anterior chamber.The goal of the surgery is to place a hole and support structure (suchas but not limited to a stent, lens system device, tubular lens, IOL, orlumen maintainer) through the cataractous lens 407, thus allowing lightto enter the back of the eye to the retina, improving vision.

FIG. 5 now depicts the surgical tool 100 entering the incision 401 in alinear direction of travel 501, as depicted by way of 501. Note that thesurgical tool 100 is placed in such a way as to clear any arid ailobstructions. Once the surgical tool 100 is in a position where theguiding structure or guide wire (not shown in FIG. 6) may be directedtoward the visual axis and center of the lens, the surgical tool 100 isrotated in a rotational direction of travel 601 such that a pinhole andrelated lens system device deployment may be made. FIG. 7 shows thesurgical tool in the proper position after rotation.

In FIG. 8, a guide wire or guiding apparatus 201 or similar rigidstructure is inserted in the hollow of the surgical tool 100, passedthrough the hollow of the surgical tool 100, and allowed to exit thesurgical tool 100 in such as a way as to create a pinhole, track,passageway or lumen through the lens. The guide wire or guidingstructure 201 may include plastics, balloons, flexible wires, catheters,needles, hollow pipes, fiberoptic cables, rotational drills, ultrasound,electrocautery, lasers including femtosecond, continuous wavelength, NDYAG, and other methods to generate heat or other types of energy topierce the anterior lens capsule and then the entire lens to create theopening through that lens. Any or all of these techniques may also beused to create a space for insertion of a guide wire and with or withoutsimilar methods for the passage of the ultimate cannula, stent, lenssystem (expandable lens in some embodiments) that eventually maintainsthe patent opening through the cataract. In some embodiments of thepresent invention, a fiberoptic cable or strand may be used to maintainpatency of the opening, and, in some embodiments of the presentinvention, may be used to bypass a cataract. In some embodiments of theinvention the lens device system or stent is passed over the guidingstructure into the lens for its deployment, in other embodiments, theguiding structure and or guide wire may be passed into the lenssimultaneously with the lens device system or stent, such that theguiding apparatus essentially allows for the positioning, deployment,and eventual release of the lens device system, expandable intraocularlens, stent, or lumen creation device. The guiding apparatus can be partof, or one in the same, as the surgical tool itself.

In FIG. 9, once the initial hole, passageway lumen or small tunnel iscreated in the lens, a stent assembly, or lens system 901 or similarstructure is conveyed to or through the smaller lumen along the wireusing guiding techniques such as guiding structures and the like. Or,the guiding structure could simply advance the lens or stent systemprimarily into the cataractous lens so it can be deployed. This guidingstructure 201 may also consist of release mechanisms such as a doublebarrel design whereby the inner guiding structure is used to advance thelens piercing and/or lens device system into the cataract, and the outerportion is able to place counter traction on the lens device system,stent, or lumen such that the guiding structure can be removed, pulledaway, and/or separated from the lens device system, stent, or lumen, andthe in situ cataract without dislocating or otherwise destabilizing thenew integrated relationship between cataract and lens device system,stent or lumen. Release mechanisms different from the double barreldesign are other embodiments of this invention. Such release systemswould allow for the separation of the guiding structure and lens devicestructure via severing the guiding structure from the stent or lensdevice system anteriorly or proximal to the lens device system or stent.Methods to accomplish this separation include but are not limited to atriggered release system activated mechanically through, for example, afine wire, or though a micromachine or microelectromechancial systemthat can be turned on by a remote electromagnetic signal, or by a heator electrically activated release mechanism whereby the portion of theguiding structure just proximal to the lens device system or stent isdesigned to melt, break, or become extremely weak to axial motionfollowing activation. Thus, the lens device, system, lumen, expandabletubular lens, or stent could be left in place in the cataract afterdeployment or placement (and subsequent removal of the surgical tool orguiding structure from the eye) with minimal additional tissue traumathereby reducing risks of lens subluxation, dislocation, or damage. Thediameter of the initial piercing of the lens creating the pinhole,lumen, or tunnel, at first is typically between one and two millimeters,but may be between 0.10 mm. and 5 mm. In some embodiments, the corneamay also be entered from the peripheral cornea using a guiding surgicaltool depicted in FIG. 1 that may have memory to bend, redirect theguide, catheter, wire, insertion system and lens system deviceposteriorly through the lens so that the eye need not be entered throughthe central cornea. In such a case, there would be a small cornealincision made with a separate blade or needle, and then the lens devicesystem/guiding structure with curvature memory could be advanced intothe eye, or the straight guiding structure/lens device deployment systemapparatus with memory for curvature may penetrate the outer corneadirectly with a sharp tip. There may be a secondary aspect to such astraight placement system such that an outer shell, sleeve or doublebarrel system allows for the memory or curvature to become manifestfollowing the retraction or removal of the outer shell, sleeve or outerhollow barrel. The stent or lens system device 301 is placed in or nearthe visual axis of the eye. In some embodiments of the presentinvention, the stent or lens system device 301 is placed outside thevisual axis of the eye, but is still able to improve sight. In someembodiments of the present invention, the lens system device, stent,small diameter cannula or other pinhole device may be mechanicallyforced through the cataractous lens using a mechanical system such as aspring loaded mechanism or screw/threaded rotational mechanism or thelike. A mechanism to force insertion of the lens system device, stent orother pinhole device may also be electrically or battery powered, andmay, in some embodiments, include a hand powered, mechanical orelectrical system to drive the lens system device, tubular lens, stentor other pinhole device carefully through the lens. The mechanicalenergy system aspect of the device may utilize heat energy, ultrasound,laser, cautery, ionization, or other electromechanical energies to easeplacement through the cataractous lens. Such mechanisms may also beused, in some embodiments of the present invention, to help drive theguide wire through the lens. In this described procedure, the pupil maybe dilated or may be undilated. The procedure may be used withviscoelastic materials or without, and may include, in some embodimentsof the present invention, a self healing incision. An irrigation systemmay be a part of the device or the deployment system of the presentinvention in some embodiments of the present invention. Some embodimentsof the present invention may include an intraocular lens within thestent assembly 901. The intraocular lens is placed through the cataract,without removing the cataract. The intraocular lens will have a smalldiameter optic, for example, less than 4 mm. The lens may be flexible,expandable, or rigid, and may be preloaded in the surgical end of theoperative tool or the operative end of the tool and then subsequentlyadvanced through the bend in the tool during use. The same conceptapplies to any stent or lens system device that may be deployed by theapparatus—it may be preloaded in the surgical or operative end of thetool, or it may be secondarily advanced over a guide wire or secondarilyplaced with a separate guiding structure. Furthermore, after creatingthe opening through the cataract, a piggy back intraocular lens, orlarger optic may he placed in the anterior chamber or in the anteriorsegment in front of the cataract but behind the iris to help focus lighton the retina. The human lens, tor reference, is 9 mm. in diameter and 4mm. thick. Standard optics used in cataract surgery have an opticdiameter between 6 mm and 4 mm. In some embodiments of the presentinvention, the stent may be conical with the anterior opening largerthan the posterior opening. A wide angle lens to allow for a largerfield of view on the retina may be utilized in this system. The stent orintraocular lens may, in some embodiments of the present invention, havea flexible flange on the lead end and trailing end of the stent, tubularlens, or lens device system to help secure it in position, enhanceintegration with the in situ lens capsule, and prevent egress ofcataractous material. The intraocular lens may further, in someembodiments of the present invention, be telescoping. The lens systemdevice may come in various powers to optimally correct for refractiveerror.

In FIG. 10, the lens system device 301 is properly positioned in andthrough the cataract, and the guiding structure 201 is retracted throughthe surgical tool 100. These methods may be performed by a physician ora non-physician under topical, local, or general anesthesia. The methodsmay be performed with or without the use of viscoelastic material orbalanced saline irrigation. The lens system device 301 (including suchdevices as stents, cables, cannulas, catheters, a clear tunnel,intraocular lens systems, tubular lenses, expandable lenses, or polymerlenses) extends through the entire lens of the eye. The length of thisstent, cable, new lumen, lens system, or material, can extend 3 mm infront of the anterior surface of the lens and up to 18 mm posterior tothe posterior capsule of the lens. Typically the length will extend 0.5to 2 mm anteriorly and 0.5 to 3 mm posteriorly through the lens.

FIG. 11 depicts the lens system device 301 after expansion, or the way anonexpendable cannula will appear. Techniques to expand a stent are wellknown to those skilled in the art, and include self expanding stents,expansion by a balloon mechanism, and the like. The lens system device301 after expansion creates a lens, passageway for light, or patentlumen in the lens of a mammal. In one embodiment, the stent or cannulasystem is non expandable. In another, it is expanded to 2 mm indiameter, up to 4 mm in diameter. The lens system device may also bemade from a hydrophilic material that expands upon placement in anaqueous environment such as an eye. Suitable hydrophilic materials mayinclude, but are not limited to, Hema (Poly-hydroxy-ethylenethacrylate), 2-hydroxyethyl methacrylate (HEMA), hydrophilic acrylic, 2HEMA hydrophilic acrylic, hydrogels, hydrophilic polymers,fluorocarbon-sulfone.

FIG. 12 shows the lens system device 301 fully installed, with therelated surgical tools removed. In FIG. 12, the lens system device 301has a taper 303. Other embodiments of the present invention may have amodified taper, or no taper, such as depicted in FIG. 13. The taper,and/or the external surface of the stent, tubular lens, or lens systemdevice, may have threads to assist its deployment into the cataractouslens, and the tapered aspects may convey other mechanical advantages.

Light ray tracing analysis shows that a reasonable image can be formedon the retina using an intraocular pinhole system, and one embodiment ofthis invention is an intra-cataract pinhole intraocular lens system.

It is, therefore, apparent that there has been provided, in accordancewith the various objects of the present invention, an apparatus andmethod for the treatment of cataract. While the various objects of thisinvention have been described in conjunction with preferred embodimentsthereof, it is evident that many alternatives, modifications, andvariations will be apparent to those skilled in the art. Accordingly, itis intended to embrace all such alternatives, modifications andvariations that fall within the spirit and broad scope of the presentinvention and the various embodiments described and envisioned by thisspecification, claims, and attached drawings.

What is claimed is:
 1. A method for readying an apparatus for treatingcataract of an eye, the method comprising: placing a flexible guidingstructure and a lens system device in a surgical tool formed with anangle that is within sixty degrees greater or less than ninety degreesto allow entry of the surgical tool through the peripheral cornea of theeye, the angle creating a longer operative end of the surgical tool anda shorter surgical end of the surgical tool such that the lens systemcan be deployed into the in situ lens, and where the guiding structurehas flexibility that makes it capable of traveling through the angle ofthe surgical tool.
 2. The method of claim 1, wherein the lens systemdevice is an expandable tubular lens comprising a hydrophilic material.3. The method of claim 1, wherein the lens system device is a stent. 4.The method of claim 1, wherein the lens system device is a conicalstent.
 5. The method of claim 1, wherein the lens system device is adrug eluting stent.
 6. The method of claim 1, wherein the lens systemdevice comprises an expandable hydrophilic material.
 7. The method ofclaim 1, wherein the lens system device is foldable.
 8. The method ofclaim 1, wherein the lens system device comprises an intraocular lens.9. The method of claim 1, wherein the lens system device is surroundedby a biocompatible shell.
 10. The method of claim 1, wherein thesurgical tool has a sharp edge.
 11. The method of claim 1, wherein theguiding structure of the surgical tool is a guide wire.
 12. A method forreadying an apparatus for treating cataract of an eye, the methodcomprising: attaching a lens system device to a surgical tool having aguiding structure wherein the surgical tool is formed with an angle thatis within sixty degrees greater or less than ninety degrees to allowentry of the surgical tool through the peripheral cornea of the eye, theangle creating a longer operative end of the surgical tool and a shortersurgical end of the surgical tool such that the lens system can bedeployed into the in situ lens, and where the guiding structure hasflexibility that makes it capable of traveling through the angle of thesurgical tool.
 13. The method of claim 12, wherein the lens systemdevice is attached to the guiding structure of the surgical tool.
 14. Amethod for manufacturing an apparatus for treating cataract of an eye,the method comprising: placing a flexible guiding structure and a lenssystem device in a surgical tool formed with an angle that is withinsixty degrees greater or less than ninety degrees to allow entry of thesurgical tool through the peripheral cornea of the eye, the anglecreating a longer operative end of the surgical tool and a shortersurgical end of the surgical tool such that the lens system can bedeployed into the in situ lens, and where the guiding structure hasflexibility that makes it capable of traveling through the angle of thesurgical tool.
 15. An expandable tubular lens for in situ placement in acataractous lens, the expandable tubular lens comprising a hydrophilicmaterial.